Rolando Evangelista Beloso

{Your Address}
{Your Phone Number
Email

{Company}
{Address}

February 7, 2022

Dear PSAHelpline,

I, Rolando Evangelista Beloso, allow my child, Catherine Beloso, for the request
of my PSA Certificate with a reason that I am currently staying and working in Italy and I
lost the original copy of my birth certificate. Rest assured that the purpose of this letter as a
formal request is to receive my official birth certificate for my renewal of passport.

My full name is Rolando Evangelista Beloso is and I am a Male.

I would like to request my:

 Long Form Birth Certificate (Certified both Hard and Soft Copy)

I, the requestor, am the person whose name is on the certificate. Kindly mail it to the
address listed above.

Rest assured that I am also enclosing a payment for the required fee.

Thank you for your consideration. Please contact me at {phone number} or {email
address} if you have any questions and concerns.

Sincerely,

{Sender Name}